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Barriers to Service Delivery and Monitoring Form
Domestic Victims of Human Trafficking Program Data
OMB: 0970-0542
IC ID: 239404
OMB.report
HHS/ACF
OMB 0970-0542
ICR 202108-0970-011
IC 239404
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0542 can be found here:
2023-10-27 - No material or nonsubstantive change to a currently approved collection
2022-10-20 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 4
Barriers to Service Delivery and Monitoring Form
Form
4 Barriers to Service Delivery and Monitoring Form
4 - OTIP-0564 - DVHT New - Barriers to Service Delivery and Monitoring Form CLEAN.pdf
Form
4 Barriers to Service Delivery and Monitoring Form
4 - OTIP-0564 - DVHT New - Barriers to Service Delivery and Monitoring Form CLEAN.pdf
Form
DVHT Grantee Reporting Reference Guide_1.21.20.docx
DVHT Grantee Reporting Reference Guide
IC Document
DVHT Grantee Reporting Reference Guide_1.21.20.docx
DVHT Grantee Reporting Reference Guide
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Barriers to Service Delivery and Monitoring Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
4
Barriers to Service Delivery and Monitoring Form
4 - OTIP-0564 - DVHT New - Barriers to Service Delivery and Monitoring Form CLEAN.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
36
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
180
0
0
0
0
180
Annual IC Time Burden (Hours)
30
0
0
0
0
30
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
DVHT Grantee Reporting Reference Guide
DVHT Grantee Reporting Reference Guide_1.21.20.docx
01/23/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.